Metastatic septic bacterial endophthalmitis is a rare but potentially devastating, serious disease. Endophthalmitis arising from Klebsiella pneumoniae liver abscess has been reported with diabetes mellitus as a major associated condition in Taiwan, but is rarely seen in patients without diabetes. There is often a delay in diagnosing endogenous bacterial endophthalmitis, particularly when there is no evidence of a primary infection or ocular infection is initial manifestation of sepsis. We report a non-diabetic patient with sepsis with right eye discomfort. Five days after admission, blood culture grew K. pneumoniae. Abdomen computerized tomography scan confirmed the presence of multiloculated liver abscess in right lobe. Despite intensive treatment, systemic and intravitreal antibiotics, liver abscess was resolved completely, but visual outcome was very poor. Physicians should be alerted to endogenous endophthalmitis in patients with Klebsiella septicemia, especially in diabetics with pyogenic liver abscess complains of ocular symptoms.
Abdomen ; Anti-Bacterial Agents ; Diabetes Mellitus ; Endophthalmitis* ; Eye Infections ; Female ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Pneumonia ; Sepsis ; Taiwan

BACKGROUND/AIMS: Gastritis cystica profunda (GCP) is a rare disease that is characterized by a hyperplastic and cystic dilatation of the pseudopyloric gland with submucosal invasion. GCP is regarded as a benign lesion. However, there is some controversy regarding its malignant potential. This study reviewed the clinical features and association with malignancy. METHODS: From January 2001 to June 2005, 1,010 cases of resected and 1,228 cases of an endoscopic mucosal resection or polypectomy were examined. RESULTS: Thirty-nine cases (1.7%) were confirmed pathologically and were not associated with prior gastric surgery mostly. The mean age was 60.0+/-11.4 years old and there were 29 male patients. The body was most commonly located on the longitudinal axis (57.1%). Eleven cases (28.2%) were not associated any other gastric lesion, the majority of which were the polypoid type (82.0%). However, two cases were found as a hypertrophic mucosal fold, and a submucosal tumor, respectively. Seventeen cases (43.6%) were associated with early gastric cancer. CONCLUSIONS: Despite its rarity, GCP should be considered when an endoscopically polypoid lesion or submucosal tumor (SMT) is found. Because of its association with early gastric cancer or adenoma, more study will be needed to examine the relationship between GCP and gastric carcinogen
Adenoma ; Axis, Cervical Vertebra ; Dilatation ; Gastritis* ; Humans ; Male ; Rare Diseases ; Stomach Neoplasms

Cytomegalovirus (CMV) infection is one of important opportunistic infections and cause significant morbidity and mortality in immunocompromised patients. The colon, stomach, and esophagus are the organs frequently involved with CMV infection. CMV enteritis makes up less than 10% of the CMV gastroenteritis cases, usually presents with diarrhea, bleeding and perforation. Several reports have described patients with acquired immune deficiency syndrome (AIDS) in whom CMV enterocolitis were complicated by ileal perforation, but have been rarely reported in Korea. We report a case of multiple ileal perforation associated with CMV enteritis in 67 years old man who was diagnosed as AIDS later. He complained of hematochezia and abdominal pain. During emergency operation, multiple perforated lesions were seen at the distal ileum above ileocecal valve. Colonoscopic examination revealed multiple shallow aphthoid ulcers at descending colon. CMV enteritis and colitis were diagnosed by microscopic findings of both surgical and endoscopic specimens. He was recovered by antiviral therapy with ganciclovir.
Abdominal Pain ; Acquired Immunodeficiency Syndrome* ; Aged ; Colitis ; Colon ; Colon, Descending ; Cytomegalovirus* ; Diarrhea ; Emergencies ; Enteritis* ; Enterocolitis ; Esophagus ; Ganciclovir ; Gastroenteritis ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Ileocecal Valve ; Ileum ; Immunocompromised Host ; Intestinal Perforation ; Korea ; Mortality ; Opportunistic Infections ; Stomach ; Ulcer

BACKGROUND/AIMS: This study reviewes the clinicopathological features, prognosis, and differences in the expression of p53 and Ki-67 immunochemical staining in squamous cell and adenosquamous carcinoma of the stomach. METHODS: From January 1995 to June 2005, 2,282 cases of gastric carcinoma were resected surgically in our hospital and 191 additional cases were resected by endoscopic mucosal resection. Retrospective pathologic review and immunochemical staining of p53 and Ki-67 were performed. RESULTS: The study consists of eight cases (0.032%) of primary squamous cell carcinoma (one case) and adenosquamous carcinoma (seven cases) without early gastric cancer. Six cases (75.0%) were male and two cases were female. The mean age was 66 year-old. The clinical presentation and physical findings did not differ from those of adenocarcinoma. The mean tumor size was 5.2+/-1.7 cm. Macroscopically, five were Borrmann type 3 (62.5%) and three were type 2. At the initial diagnosis, six (75%) were stage IV based on TNM tumor staging. Six cases (75%) progressed despite the therapy while two cases responded to the treatment. The median survival time was 11.0 months (range 4.3+/-17.7). Overexpression of p53 was seen in five cases (62.5%) and their survival was poor when compared to the p53-negative group (p=0.04). The mean Ki-67 labeling index was 70.0+/-20.8%, and was not associated with p53 staining (p>0.05). CONCLUSIONS: Adenosquamous and squamous cell carcinoma of the stomach are very rare. They tend to be at advanced stages on initial diagnosis, and progress rapidly. They show p53 protein overexpression and high Ki-67 labeling index, which might be related to poor prognosis.
Adult ; Aged ; Carcinoma, Adenosquamous/chemistry/mortality/*pathology ; Carcinoma, Squamous Cell/chemistry/mortality/*pathology ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen/*analysis ; Male ; Middle Aged ; Stomach Neoplasms/chemistry/mortality/*pathology ; Survival Rate ; Tumor Suppressor Protein p53/*analysis

Extramedullary plasmacytoma(EMP) comprises 5% of all plasma cell neoplasms and commonly occurs in the upper airway or digestive tract. However, it rarely develops in the lungs. We present a case of primary pulmonary plasmacyotma in a 45 year old man, who presented as an endobronchial mass with a pleural effusion, but without evidence of multiple myeloma. The treatment options for EMP include surgery, surgery and radiotherapy, surgery and chemotherapy or chemotherapy alone. Surgery and radiation therapy appeared to be equally effective forms of treatment. The local recurrence rate was reported to be 30%, with 48% progressing to multiple myeloma, and median survival was reported to be 63-101 months. Our patient was initially treated with melphalan and prednisolone. However the disease progressed, and radiotherapy was combined with chemotherapy. In addition, the chemotherapy regimen was also changed to thalidomide and dexamethasone. The patient did not respond to this treatment regimen and finally died.
Dexamethasone ; Drug Therapy ; Gastrointestinal Tract ; Humans ; Lung ; Melphalan ; Middle Aged ; Multiple Myeloma ; Neoplasms, Plasma Cell ; Plasmacytoma* ; Pleural Effusion ; Prednisolone ; Radiotherapy ; Recurrence ; Thalidomide